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Hypertensive emergency with encephalopathy — SCE Acute Medicine MCQ

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EasyAcute Cardiac PresentationsHypertensive emergency with encephalopathySCE Acute Medicine

A 56-year-old man is assessed on the acute medical unit. He presents with confusion, vomiting and blood pressure 236/132 mmHg. Fundoscopy shows papilloedema and CT head shows no haemorrhage. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: D — Lower blood pressure cautiously with intravenous therapy

Lower blood pressure cautiously with intravenous therapy is the best answer because acute target-organ damage from severe hypertension requires controlled intravenous blood pressure reduction. Start intravenous N-acetylcysteine promptly is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Rapid overcorrection can precipitate cerebral or myocardial ischaemia.

Reference: NICE hypertension guidance; BHS guidance